Individual
SHANNON LYNN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
400 S 43RD ST, RENTON, WA 98055-5714
(425) 690-3650
Mailing address
3600 LIND AVE SW, SUITE 100 ATTN CREDENTIALING, RENTON, WA 98057-4970
(425) 690-2715
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT00002086
WA
225XH1200X
Hand Occupational Therapist
OT00002086
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0291600
DEPT. OF LABOR AND INDUSTRIES
WA
05
—
1578799722
—
WA
Enumeration date
06/02/2009
Last updated
11/29/2021
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